Clinical Pharmacy Practice Research Articles

Identifying disruptive papers in pharmacy literature that changed clinical practice: 1954-2014.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. This study aimed to identify research publications that have significantly influenced clinical practice in pharmacy using a novel metric known as the disruption score. We conducted a bibliometric analysis and PubMed search of pharmacy practice articles published in 11 key pharmacy journals and articles tagged with the MeSH term "pharmacy" or "pharmacist." Utilizing a validated dataset of disruption scores encompassing articles published between 1954 and 2014, we identified the top 100 most disruptive papers alongside the top 100 most cited papers. Additionally, we explored comparisons between these lists and across various journals to gain comprehensive insights into the field's evolution over time. A total of 59,535 articles met the inclusion criteria, of which 56,764 (95%) were published in the 11 core pharmacy practice journals we chose while 2,771 (5%) were published in other PubMed-indexed journals. Notably, the top 100 most disruptive papers were deemed more disruptive than 99.9% of the entire PubMed universe. The most cited paper was the 22nd most disruptive paper. The mean citation count among the top 100 most disruptive papers was 196. The 1990s was the most disruptive decade, and American Journal of Health-System Pharmacy was the most disruptive journal. We observed a weak correlation between disruption score and citation count. The disruption score identified an innovative body of landmark papers whose legacy will remain solidified in pharmacy practice. The disruption score offers a unique perspective on clinical significance, complementing other bibliometric indices and adding to the identification of papers that have introduced new paradigms in pharmacy.

Neuromuscular monitoring: A tutorial for pharmacists.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. To describe neuromuscular monitoring modalities and highlight the importance of neuromuscular monitoring to clinical pharmacy practice. A growing body of literature and clinical practice guidelines have highlighted the importance of neuromuscular monitoring practices to ensure patient safety during surgery and in the intensive care unit. Understanding neuromuscular monitoring modalities can allow pharmacists to enhance participation in institutional discussions and optimization of neuromuscular blocker administration and reversal practices. We have described the various modalities of neuromuscular monitoring and considerations for using different modalities. Neuromuscular monitoring should be performed whenever neuromuscular blocking agents are administered. This practice represents an evidence-based approach to minimizing the occurrence of residual neuromuscular blockade and its associated complications.

Addressing the second victim phenomenon among community pharmacists and its impact on clinical pharmacy practice: a consensus study.

The second victim phenomenon, denoting the harmful effects of patient safety incidents on healthcare practitioners, remains insufficiently examined within the pharmacy workforce. This study aimed to investigate the second victim phenomenon in community pharmacies, focusing on its triggers, impacts on pharmacists' well-being, and effects on pharmaceutical care and safety. This consensus study with the Nominal Group Technique involved 27 community pharmacists in three equal groups. The final ranks of the statements scored by participants from 5 to 1 were recalculated using the Van Breda method, combining three distinct data sets with higher values for a higher impact on the output evaluated. Statistics were applied to ascertain event distribution and investigate the potential relationships between event categories and outcomes for patients and pharmacists. "Patient-centric anxiety" (6.8) was the top mental health issue, followed by "Personal responsibility and resilience" and "Future concerns and career aspirations" (6.0 each). The dominant support was "Colleague/Peer support" (5.3). The most frequent patient safety incidents were "Inadequate pharmaceutical service" (8.0) and "Wrong drug dispensed" (7.8). Most errors (63%) were dispensing failures, primarily wrong drug dispensed (44.4%). Of these, 50% were near misses, 25.0% caused no harm, and 16.7% had serious consequences. Field notes suggest contributing factors like inadequate supervision, crowding, and storage issues. This study revealed the second victim phenomenon among pharmacists, which potentially stems from breaches in practice standards. The impact on the quality and safety of pharmaceutical care and its influence on pharmacists' well-being should be studied in further studies.

Sentiment analysis in medication adherence: using ruled-based and artificial intelligence-driven algorithms to understand patient medication experiences.

Studies are exploring ways to improve medication adherence, with sentiment analysis (SA) being an underutilized innovation in pharmacy. This technique uses artificial intelligence (AI) and natural language processing to assess text for underlying feelings and emotions. This study aimed to evaluate the use of two SA models, Valence Aware Dictionary for Sentiment Reasoning (VADER) and Emotion English DistilRoBERTa-base (DistilRoBERTa), for the identification of patients' sentiments and emotions towards their pharmacotherapy. A dataset containing 320,095 anonymized patients' reports of experiences with their medication was used. VADER assessed sentiment polarity on a scale from - 1 (negative) to + 1 (positive). DistilRoBERTa classified emotions into seven categories: anger, disgust, fear, joy, neutral, sadness, and surprise. Performance metrics for the models were obtained using the sklearn.metrics module of scikit-learn in Python. VADER demonstrated an overall accuracy of 0.70. For negative sentiments, it achieved a precision of 0.68, recall of 0.80, and an F1-score of 0.73, while for positive sentiments, it had a precision of 0.73, recall of 0.59, and an F1-score of 0.65. The AUC for the ROC curve was 0.90. DistilRoBERTa analysis showed that higher ratings for medication effectiveness, ease of use, and satisfaction corresponded with more positive emotional responses. These results were consistent with VADER's sentiment analysis, confirming the reliability of both models. VADER and DistilRoBERTa effectively analyzed patients' sentiments towards pharmacotherapy, providing valuable information. These findings encourage studies of SA in clinical pharmacy practice, paving the way for more personalized and effective patient care strategies.

Study on the Management of Diabetic Foot Ulcer in Diabetic Patients at a Tertiary Care Hospital

AIM: To study the treatment pattern of diabetic foot ulcer and to assess the effect of patient counselling on diabetic foot ulcer patients. OBJECTIVE: 1. To study the various modalities of treatment used for Diabetic Foot Ulcer patients in a tertiary care hospital. 2. To assess the effect of patient counselling on diabetic foot ulcer patients with standard questionaries METHODS: The protocol was reviewed, revised, and approved by the Institutional Review Committee of MVJ Medical College and Research Hospital before commencement of the study. Over the course of six months, a tertiary care hospital conducted prospective research. Following the giving of written informed permission, diabetic patients with foot ulcers of both genders who were visiting the hospital were invited to participate and enrolled. A total of 150 patients participated in the study. The patients were recruited according to the inclusion and exclusion criteria mentioned. The study was attempted to improve the patient’s knowledge and attitude towards the self-management of diabetic foot ulcer. And thus, patient counselling is an essential component of clinical pharmacy practice in hospital. RESULTS: In this study, majority of the study participants belonged to the age group 61-70 years (30.7%) of age. 22% of the study participants were of the age group between 51-60 years of age. Majority (64.7%) of the study participants were males. In this study, Nottingham Assessment of Functional Footcare (Revised 2015) was used and an improvement in the total score was found i.e., from 18.27+5.85 before counselling jym oof ff\c b to 44.07+4.70 post counselling which was found to be statistically significant (P<0.001). Thus, a proper foot care education program has been shown to reduce the risk of ulceration. CONCLUSION: The present study was conducted to study the effect of patient counselling on diabetic foot ulcer patients using NAFFC score. Majority in the study belonged to 61-70 years and were males. Most of them had type 2 DM and grade 1 foot ulcer. In this study, Nottingham Assessment of Functional Footcare (Revised 2015) was used and an improvement in the total score was found i.e., from 18.27+5.85 before counselling to 44.07+4.70 post counselling which was found to be statistically significant (P<0.001). NAFFC score played an important role in the study to assess the functional outcome among diabetics with foot ulcers. Though there is development of new therapies for the management of diabetic foot ulcers, a high rate of failure ending with amputation still exists. Hence a counselling session to the diabetics with foot ulcers can prevent further complications.

The International Collaboration of Pharmacy Journal Editors (ICPJE)formally constituted to foster quality around clinical and social pharmacy practice research publications

The International Collaboration of Pharmacy Journal Editors (ICPJE)formally constituted to foster quality around clinical and social pharmacy practice research publications

Medication reconciliation enhances the accuracy of gastric emptying scintigraphy

BackgroundGastroparesis (GP) is a prevalent sensorimotor disorder characterized by delayed gastric emptying without mechanical obstruction, posing significant diagnostic challenges. Gastric emptying scintigraphy (GES) is the gold standard for diagnosing GP. However, its accuracy can be compromised by many medications that affect gastric motility. This study evaluates the impact of medication reconciliation on the diagnostic accuracy of GES.ResultsA significant proportion of patients (75%) were on medications known to affect gastric motility. Recommendations for medication adjustments were communicated, with 30% non-adherence. Adjustments in GES interpretations were necessary for 20% of patients following comprehensive medication reviews. The involvement of radiopharmacists facilitated accurate diagnostic conclusions, underscoring the critical role of medication reconciliation in GES accuracy.ConclusionMedication reconciliation enhanced the accuracy of GES in diagnosing gastroparesis, emphasizing the need to integrate clinical pharmacy practices into nuclear medicine. This interdisciplinary approach not only improves diagnostic accuracy but also enhances patient safety, advocating for the adoption of such practices in the management of gastroparesis.

Prevalence of inappropriate antibiotic doses among pediatric patients of inpatient, outpatient, and emergency care units in Bangladesh: A cross-sectional study.

The heterogeneous pediatric populations, their physiological differences, along with the necessity of performing additional dose calculation, make the pediatric population more vulnerable to the incidences of inappropriate antibiotic doses. This study was conducted to examine and evaluate the appropriateness of antibiotic doses. A cross-sectional study with a quantitative approach was conducted in three hospitals located in Savar from January 06, 2021 to October 17, 2022. This study had used a convenient sampling method to collect 405 filled prescription orders from heterogeneous pediatric patients prescribed by physicians from emergency, inpatient, and outpatient care units of various clinical settings. The Harriet Lane Handbook was used as reference to investigate inappropriate doses of antibiotics. Subsequently, all analyses were conducted using the RStudio 1.3.959 software. Binary logistic regression was used to assess the risk of inappropriate antibiotic prescription in pediatrics. The overall prevalence of inappropriate antibiotic dosing in pediatrics was 335 out of 545 (61.5%). Overdosing (36.3%) and oral antibiotic prescriptions (64%) were more common than underdosing (20.4%) and parenteral antibiotics (36%). The majority (230 out of 405, 56.8%) of pediatric patients had prescriptions with inappropriate antibiotic doses, with prevalence rates of 33.8% for inpatients, 86.7% for outpatients, and 50% for emergency pediatrics. The results also indicated that pediatric patients in outdoor and emergency care units, infants, toddlers, and early childhood, those prescribed two antibiotics simultaneously, and those receiving parenteral antibiotics, were less likely to have inappropriate antibiotic dosages in their prescriptions. This study demonstrated that about one out of every two prescriptions had inappropriate antibiotic doses; in particular, prescriptions containing only one antibiotic exhibited a substantial proportion of inappropriate antibiotic doses. Inappropriate antibiotic doses may result in therapeutic failure, patient harm, and antibiotic resistance. Good clinical pharmacy practice and careful adherence to pediatric dosing standards may minimize inappropriate antibiotic doses.

Pharmacy practice and policy research in Türkiye: a systematic review of literature.

In recent decades, there has been an interest in clinical pharmacy practice in Türkiye with emerging studies in this area. Despite the recent emergence of diverse pharmacy practice studies in Türkiye, a comprehensive assessment of overall typology of studies and impact has not been conducted thus far. This systematic review aims to document and assess pharmaceutical policy and practice literature published within the last 5 years in Türkiye. The other aim is to summarise the expected impact of published studies on policy and practice research. The systematic review was conducted according to the guidelines described in the PRISMA Statement. A comprehensive search approach, incorporating Medical Subject Headings (MeSH) queries and free-text terms was employed to locate pertinent literature related to pharmacy practice and policy in Türkiye. The search covered the period from January 1, 2019, to January 1, 2024, and involved electronic databases including PubMed, Medline Ovid, Scopus, ScienceDirect, Springer Link, PlosOne, and BMC. In the final grouping, 73 articles met the inclusion criteria and were selected for this review. Among the quantitative studies, majority studies were cross-sectional survey studies. Through the rigorous thematic content analysis seven research domains were developed from the selected literature: drug utilisation and rational drug use, the emerging role of pharmacist, access to medicines and generic medicines, community pharmacy practice, pharmacovigilance/adverse drug reactions, and pharmacoeconomic studies. The pharmacist role is evolving; however, several challenges remain in fully realising the potential of pharmacists. These include regulatory barriers, limited public awareness of pharmacists' expanded roles, workforce capacity issues, and the need for ongoing professional development and training. Research studies are needed in the areas of generic prescribing, medicine adherence, intervention studies in community and hospital pharmacy practice, and on pharmacoeconomics and pharmacovigilance.

Exploring the need and potential of ambulatory pharmacy practice for empowering patient and care delivery in India.

In recent years, rapidly changing disease profile patterns, shortage & uneven utilization of healthcare professionals contributed massive burden on the Indian healthcare system, which resulted in varying, fragmented, inconsistent healthcare delivery to the patients and poor patient management. Patients often face and experience many challenges like lack of accessibility, poor patient-healthcare provider relationships, and inadequate quality of care, resulting in unnecessary economic burden in managing their health conditions. Thus Indian healthcare reform is essential in enhancing its capacity to fulfill patients' health needs that can be addressed by focusing on key sustainable strategies and initiatives meant for enhancing coordination of care, expanding services accessibility, redeveloping healthcare infrastructure, implementing workforce innovation and strong governance with the incorporation of core principles such as patient-centeredness, integrated care and collaborative care approaches. The clinical and ambulatory pharmacy practice are fragment of the healthcare delivery which delivers pharmaceutical care and fulfils the needs of patients across healthcare settings. This paper focuses on the present & future perspectives of ambulatory pharmacy practice in India and the factors to be considered for implementing it in patient care.

Lessons Pharmacy Practice in India Should Adopt From Advanced Nations: A Review.

In India, pharmacy practice is still at a developing stage with the majority of the graduates taking the industry pathway. Currently, there are only a few pharmacists who have been board-certified by the Board of Pharmacy Specialities (BPS), which is the most established pharmacist board certification programglobally. Even though India is the largest global exporter of generic medications, pharmacy practice is yet to gain stronghold within its healthcare scenarios. In this article, we aim to examine the development of pharmacy practice from a global viewpoint and scale down to the recent modern practice, particularly in advanced nations. Furthermore, we assess the ways through which pharmacy practice can be enhanced in India. Notably, with several pharmacy practice graduates completing their studies in India yearly, pharmacy practice is projected to significantly grow in the coming years. Gaining a proper understanding of and embracingadvanced clinical pharmacy practices will improve the domain of pharmacy practice among both junior and senior pharmacists. Moreover, enrolling in and receiving international accreditations such as the Board of Pharmacy Specializations (BPS) will validate the practice standards being offered in India as compared to other developed countries, i.e., the US. The main objective of this review is to assess various means through which pharmacy practice can be improved in India.

Optimizing short-term in-class process evaluation: analyzing the effectiveness of teaching interventions in pharmaceutical education using repeated measures analysis

BackgroundThe assessment of the effectiveness of teaching interventions in enhancing students’ understanding of the Pharmaceutical Care Network Europe (PCNE) Classification System is crucial in pharmaceutical education. This is especially true in regions like China, where the integration of the PCNE system into undergraduate teaching is limited, despite its recognized benefits in addressing drug-related problems in clinical pharmacy practice. Therefore, this study aimed to evaluate the effectiveness of teaching interventions in improving students’ understanding of the PCNE Classification System in pharmaceutical education.MethodsUndergraduate pharmacy students participated in a series of sessions focused on the PCNE system, including lectures (t1), case analyses (t2), and practical implementation (t3). The levels of understanding were evaluated using time-course questionnaires. Initially, paired samples t-Tests were used to compare understanding levels between different time points. Subsequently, Repeated Measures Analysis (RMA) was employed. Pearson correlation analysis was conducted to examine the relationship between understanding levels and the usability and likelihood of using the PCNE system, as reported in the questionnaires.ResultsThe paired samples t-Tests indicated insignificant differences between t2 and t3, suggesting limited improvement following the practical implementation of the PCNE system. However, RMA revealed significant time effects on understanding levels in effective respondents and the focused subgroup without prior experience (random intercept models: all p < 0.001; random slope models: all p < 0.001). These results confirmed the effectiveness of all three teaching interventions. Pearson correlation analysis demonstrated significant positive correlations between understanding levels and the usability and likelihood of using the PCNE system at all examined time points. This finding highlighted the reliability of the understanding levels reported in the questionnaires. The homework scores were used as external calibration standards, providing robust external validation of the questionnaire’s validity.ConclusionThe implementation of RMA provided robust evidence of the positive impact of time on understanding levels. This affirmed the effectiveness of all teaching interventions in enhancing students’ comprehension of the PCNE Classification System. By utilizing RMA, potential errors inherent in common statistical methods, such as t-Tests, were mitigated. This ensured a more comprehensive and accurate assessment of the effectiveness of the teaching interventions.

Global Trends in Key Hospital Performance Indicators: A Decade of Research Insights (2014-2023)

Background: Hospital Key Performance Indicators (KPIs) are essential metrics used to evaluate the quality of healthcare services, assess organizational efficiency, and support sustainable hospital operations. Despite the importance of KPIs in enhancing patient care and hospital management, there remain gaps in the comprehensive assessment and application of these indicators across various healthcare settings. Methods: This study employs a qualitative methodology with a bibliometric analysis to examine the trajectory of research on hospital KPIs from 2014 to 2023. A comprehensive literature review was conducted using the Scopus database, selecting 111 relevant documents based on specific keywords and criteria. The data was analyzed using VOSviewer software, focusing on Network Analysis, Overlay Visualization, and Density Visualization to map the development of KPIs in hospital research, identify key themes, and explore the evolution of these studies over the years. Results: Results from network and density analysis using VOSviewer identified four main clusters of research themes, including hospital management, quality of care, emergency services, and hospital discharge processes. Keywords such as "quality indicator" and "hospital management" were identified as emerging areas with potential for future research. Furthermore, citation analysis revealed that the most referenced studies focused on developing KPIs to enhance clinical pharmacy practice and holistic hospital management. Conclusion: The study underscores the growing global interest in hospital KPIs, with a notable concentration of research in specific areas like hospital efficiency, quality of care, and operational metrics. The analysis highlights key trends and identifies emerging research opportunities, particularly in the areas of quality indicators and hospital management practices. These insights are crucial for guiding future research and improving the implementation of KPIs in hospital settings to enhance patient care and operational efficiency.

The role of leadership and cultural barriers in the adoption of lean six sigma in clinical pharmacy practice and medicine waste reduction. The case of NHS-UK

The role of leadership and cultural barriers in the adoption of lean six sigma in clinical pharmacy practice and medicine waste reduction. The case of NHS-UK

Construction and Practice of Hospital Pharmacy Practice Teaching Mode under the Reform of DRG Payment Method

Objective: this research for DRGs payment reform, in order to build a new teaching mode of traditional pharmacy practice and DRGs payment reform background, the pharmaceutical interns add DRGs disease grouping and ICD disease coding teaching and DRGs disease grouping of pharmacoeconomics teaching, training more able to adapt to the medical reform of drug service personnel and hospital performance management and internal cost control training practical pharmaceutical service talents. Methods: Through the implementation of different internship programs, to make the effect evaluation. Results: Combining the traditional clinical pharmacy practice with the background of DRGs payment reform, the teaching of DRGs disease grouping, ICD disease coding teaching and pharmacoeconomics of DRGs disease grouping. Conclusion: In this study, the practice of Chinese pharmacy, prescription practice, clinical pharmacy and ward practice combined the teaching of DRGs disease grouping and ICD disease coding with the medical insurance department, which promoted the smooth implementation of DRGs and reflected the value of clinical pharmacists in ensuring effective, safe and economical drug use.

Perceived importance of emotional intelligence for clinical pharmacy practice and suggested improvements: a focus group study of postgraduate pharmacists.

Emotional intelligence (EI) is a critical set of skills that impacts clinical pharmacists' well-being and positively influences high-level patient-centred care. Describing pharmacists' perceptions may support the integration of EI development approaches into their professional development continuum. The aim of this study was to analyse pharmacists' perceptions of the characteristics of emotionally intelligent clinical pharmacists, the importance of EI in clinical practice, and educational models and approaches to enhancing EI. A qualitative study with a focus group methodology was conducted with pharmacy practitioners using a semi-structured guide grounded in the EI competency framework and existing qualitative research methodology practices. Purposive sampling was conducted until information and meaning saturation occurred. The focus group recordings were transcribed and independently coded by two researchers. The conventional content analysis of qualitative data was applied with the inductive thematic approach at its core. According to the 17 focus group participants, emotionally intelligent clinical pharmacists are perceived as self-confident communicators who control and manage emotions, work well under pressure, and handle every situation effectively. Emotional self-control, self-awareness, awareness of others, tolerance, understanding, and empathy have emerged as key EI competencies required for challenges in clinical practice. EI lectures with reflections from clinical applications, behaviour modelling, and behaviour-changing methods were perceived to be of particular importance for pharmacist education and development programmes. Postgraduate pharmacy practitioners perceived EI competencies as necessary for their professional success and high-quality patient-centred care. They suggested that EI competencies be a focal point in pharmacy professional development programmes.

Evaluation of a novel clinical pharmacy tool in identifying and categorising drug-related problems in hospitalised patients: The MA2VER2ICK Tool Study

Abstract Introduction Literature searching has revealed a lack of high-quality research outlining the use of tools or checklists in hospitalised patients. Additionally, few tools identified relate directly to clinical pharmacy practice. The tools identified focus on specific disciplines (e.g. critical care) or specific tasks (e.g. handover). The MA2VER2ICK Tool is a novel clinical pharmacy tool which has recently undergone review and adaptation.[1] The tool is unique as it is comprehensive and applicable to all hospitalised patients, regardless of clinical discipline. The intended purpose of the tool is to assist clinical pharmacists in comprehensive pharmaceutical care planning. Aim Demonstrate the utility of the MA2VER2ICK tool in pharmaceutical care planning, by outlining the type and frequency of drug-related problems occurring in hospitalised patients. Methods A prospective, observational, cross-sectional study was conducted in a 560-bed acute university teaching hospital. Clinical pharmacists adopted the tool in their daily practice, in a mixed medical-surgical inpatient population, over four weeks. All drug-related problems identified were recorded and assigned to the applicable category within the tool, by the clinical pharmacist. Additionally, all drug-related problems were retrospectively assigned to applicable categories of the Pharmaceutical Care Network Europe Classification for Drug Related Problems Version 9.1,[2] for comparison, by two independent researchers. Results All identified drug-related problems identified were successfully categorised using the MA2VER2ICK Tool. In total, 753 drug-related problems were identified in 180 patients over four weeks, with 233 patient-pharmacist encounters occurring. The mean age of patients was 68.9±16 years, while 51.7% (93/180) were female and 48.3% (87/180) were male. The mean number of drug-related problems identified per patient was 4.2±3.6. The highest number of drug-related problems experienced by an individual was 20, while 17 patients experienced no drug-related problem. The majority of drug-related problems identified using the tool related to medication reconciliation (52.7%; 397/753), followed by prescription endorsement and administration (17.3%; 130/753) and pharmacotherapy optimisation (9.3%; 70/753). In comparison with the MA2VER2ICK Tool, the Pharmaceutical Care Network Europe classification system has a much larger range of categories for assigning drug-related problems. Despite this, a proportion of identified drug-related problems 1.6% (12/753) could not be categorised using this tool, while there were also several categories within the tool 43.2% (19/44) whereby no drug-related problems were assigned. Conclusion This study demonstrates that the MA2VER2ICK Tool is a robust clinical pharmacy tool, that is effective and practical in assisting clinical pharmacists with the identification of drug-related problems and thus is a useful guide to facilitate pharmaceutical care planning at the patient’s bedside. This is in comparison with the Pharmaceutical Care Network Europe classification system, which has less utility as a clinical pharmacy tool, but is better placed as a research instrument. Despite demonstrating the usefulness of the MA2VER2ICK Tool in identifying drug-related problems, the clinical significance of those identified was not assessed during this study. However, data collection occurred in real time, facilitating the identification of actual and potential problems, thus reducing the likelihood of underestimating the incidence rate.

Identifying ideal pharmacist‐to‐patient ratios for the successful provision of clinical pharmacy services

AbstractClinical pharmacists add significant value to the health care team and are associated with reduced hospital mortality, drug costs, length of stay, and adverse drug reactions. However, there remains a paucity of evaluative data regarding optimal clinical pharmacy practice models. Identifying optimal patient (or bed)‐to–clinical pharmacist ratios is one mechanism to assess the allocation of resources. The ACCP Task Force on Clinical Pharmacy Services was charged with developing a white paper to examine optimal ratios in different care settings, considering confounders and other factors that affect the interpretation of ratio data. The committee performed an extensive search of the pharmacy, medical, and nursing literature to identify existing data on provider‐to‐patient ratios. Recommendations on ratios are mainly from survey data or statements from various health care organizations. Many factors affect the capacity of clinical pharmacists to achieve patient care and non‐patient care responsibilities. Examples include general differences in baseline expectations; nonstandardized program performance metrics; variable hospital/practice setting types; variable patient acuity and complexity; competing priorities and other resources; industry‐wide rates of and variability in addressing burnout; inconsistent means for justifying numbers and historical corporate structures; and external endorsements and mandates. Although some areas of practice such as critical care pharmacy have more robust evidence for specific ratios, others such as pediatrics are far less clear. A clinical pharmacist ratio must be established as a starting point. This will allow for better allocation today and serve as a springboard for future determinations. Furthermore, clinical pharmacist ratios should be preserved to offer reliable patient care 365 days per year. As clinical pharmacist services shift from beneficial to essential, continuous daily patient care services must be the practice model moving forward.

Performance of ChatGPT on Factual Knowledge Questions Regarding Clinical Pharmacy.

ChatGPT is a language model that was trained on a large dataset including medical literature. Several studies have described the performance of ChatGPT on medical exams. In this study, we examine its performance in answering factual knowledge questions regarding clinical pharmacy. Questions were obtained from a Dutch application that features multiple-choice questions to maintain a basic knowledge level for clinical pharmacists. In total, 264 clinical pharmacy-related questions were presented to ChatGPT and responses were evaluated for accuracy, concordance, quality of the substantiation, and reproducibility. Accuracy was defined as the correctness of the answer, and results were compared to the overall score by pharmacists over 2022. Responses were marked concordant if no contradictions were present. The quality of the substantiation was graded by two independent pharmacists using a 4-point scale. Reproducibility was established by presenting questions multiple times and on various days. ChatGPT yielded accurate responses for 79% of the questions, surpassing pharmacists' accuracy of 66%. Concordance was 95%, and the quality of the substantiation was deemed good or excellent for 73% of the questions. Reproducibility was consistently high, both within day and between days (>92%), as well as across different users. ChatGPT demonstrated a higher accuracy and reproducibility to factual knowledge questions related to clinical pharmacy practice than pharmacists. Consequently, we posit that ChatGPT could serve as a valuable resource to pharmacists. We hope the technology will further improve, which may lead to enhanced future performance.

Novel opportunities for clinical pharmacy research: development of a machine learning model to identify medication related causes of delirium in different patient groups

The advent of artificial intelligence (AI) technologies has taken the world of science by storm in 2023. The opportunities of this easy to access technology for clinical pharmacy research are yet to be fully understood. The development of a custom-made large language model (LLM) (DELSTAR) trained on a wide range of internationally recognised scientific publication databases, pharmacovigilance sites and international product characteristics to help identify and summarise medication related information on delirium, as a proof-of-concept model, identified new facilitators and barriers for robust clinical pharmacy practice research. This technology holds great promise for the development of much more comprehensive prescribing guidelines, practice support applications for clinical pharmacy, increased patient and prescribing safety and resultant implications for healthcare costs. The challenge will be to ensure its methodologically robust use and the detailed and transparent verification of its information accuracy.